| NPI | 1417484775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: KY 05388) |
| Additional Taxonomies | 208600000X Surgery (Licence: KY TP156) |
| 208600000X Surgery (Licence: IN 02005797A) | |
| Enumeration Date | 2017-05-17 |
| Last Update Date | 2023-01-31 |